Provider Demographics
NPI:1396774170
Name:MCGREW, DEBORAH (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MCGREW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 UNIVERSITY BLVD NE STE 3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1717
Mailing Address - Country:US
Mailing Address - Phone:505-247-4100
Mailing Address - Fax:505-796-5922
Practice Address - Street 1:1615 UNIVERSITY BLVD NE STE 3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1717
Practice Address - Country:US
Practice Address - Phone:505-247-4100
Practice Address - Fax:505-796-5922
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041110208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124536Medicaid
WAG8870001Medicare PIN
WA1124536Medicaid